Job Information
BayCare Health System Denials Specialist - Utilization Review in Morton Plant, United States
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Denials Specialist-Utilization Review responsibilities include:
Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
Location: Tampa or St Petersburg for up to first 6 months and then remote
Status: Full time - 36 hours per week
Schedule: 1st week - 5 days - 7:00 AM - 3:30 PM
2nd week - 4 days - 7:00 AM - 3:30 PM
Weekend Requirement: None
On Call: No
Benefits:
Benefits (Health, Dental, Vision)
Paid time off
Tuition reimbursement
401k match and additional yearly contribution
Yearly performance appraisals and team award bonus
Community discounts and more
Certifications and Licensure:
Required RN License
Preferred Accredited Case Manager Certification
Preferred Certified Case Manager
Education and Experience:
- Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR
Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
Preferred Masters Degree in Nursing
Preferred 2 years Case Management
Preferred 6 months Denials Management
Preferred 1 year Medicaid/Medicare experience.
Equal Opportunity Employer Veterans/Disabled
Position Denials Specialist - Utilization Review
Location Clearwater:Morton Plant | Clinical | Full Time
Req ID null
BayCare Health System
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